Insulins and the Evolving Landscape of U.S. Prescription Drug Pricing
Authors: Mariana P. Socal, Ge Bai
Journal: Annals of Internal Medicine (2023)

Ideas and OpinionsSeptember 2023Insulins and the Evolving Landscape of U.S. Prescription Drug PricingMariana P. Socal, MD, PhD, and Ge Bai, PhD, CPAMariana P. Socal, MD, PhDJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.P.S.), and Ge Bai, PhD, CPAJohns Hopkins Carey Business School and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (G.B.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1105 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The pricing of U.S. prescription drugs is complex. A drug's list price, determined by its manufacturer, is generally higher than its net price, the amount ultimately collected by the manufacturer. This is because manufacturers usually provide price concessions (rebates, discounts, and fees) to pharmacy benefit managers (PBMs), health insurers, and other supply chain entities (1). For cash-paying patients and insured patients in the deductible phase, list prices typically are aligned with their out-of-pocket expenditures (OOPs); for insured patients subject to coinsurance, list prices usually serve as the basis for calculating patients' OOPs (2, 3). Because price concessions are not passed ...References1. Bai G, Sen AP, Anderson GF. Pharmacy benefit managers, brand-name drug prices, and patient cost sharing. Ann Intern Med. 2018;168:436-437. [PMID: 29435565] doi:10.7326/M17-2506 LinkGoogle Scholar2. Anderson G. Testimony to the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP). Accessed at www.help.senate.gov/imo/media/doc/Anderson4.pdf on 1 July 2023. Google Scholar3. Academy of Managed Care Pharmacy (AMCP). Maintaining the affordability of the prescription drug benefit. Accessed at www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/Maintaining-the-Affordability-of-the-Prescription-Drug-Benefit on 1 July 2023. Google Scholar4. Socal MP, Greene JA. Interchangeable insulins - new pathways for safe, effective, affordable diabetes therapy. N Engl J Med. 2020;382:981-983. [PMID: 32160658] doi:10.1056/NEJMp1916387 CrossrefMedlineGoogle Scholar5. Levy J, Chowdhury ZM, Socal MP, et al. Changes associated with the entry of a biosimilar in the insulin glargine market. JAMA Intern Med. 2021;181:1405-1407. [PMID: 34180955] doi:10.1001/jamainternmed.2021.2769 CrossrefMedlineGoogle Scholar6. U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP). The need to make insulin affordable for all Americans. Accessed at www.help.senate.gov/hearings/the-need-to-make-insulin-affordable-for-all-americans on 1 July 2023. Google Scholar7. Socal MP, Bai G, Anderson GF. Favorable formulary placement of branded drugs in Medicare prescription drug plans when generics are available. JAMA Intern Med. 2019;179:832-833. [PMID: 30882842] doi:10.1001/jamainternmed.2018.7824 CrossrefMedlineGoogle Scholar8. Rome BN, Kesselheim AS. Will ending the medicaid drug rebate cap lower drug prices? JAMA Intern Med. 2021;181:1034-1035. [PMID: 34180958] doi:10.1001/jamainternmed.2021.2696 CrossrefMedlineGoogle Scholar9. U.S. Senate Committee on Finance. Wyden, Crapo, Menendez, Blackburn, Tester and Marshall introduce bipartisan legislation to reform PBMs and bring down the cost of prescription drugs. Accessed at www.finance.senate.gov/chairmans-news/wyden-crapo-menendez-blackburn-tester-and-marshall-introduce-bipartisan-legislation-to-reform-pbms-and-bring-down-the-cost-of-prescription-drugs on 1 July 2023. Google Scholar10. Pharmacy Benefit Manager Transparency Act of 2023, S.127, 118th Cong (2023). Accessed at www.congress.gov/bill/118th-congress/senate-bill/127/text on 1 July 2023. Google Scholar Author, Article, and Disclosure InformationAuthors: Mariana P. Socal, MD, PhD; Ge Bai, PhD, CPAAffiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.P.S.)Johns Hopkins Carey Business School and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (G.B.).Financial Support: By Arnold Ventures.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1105.Corresponding Author: Mariana P. Socal, MD, PhD, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Suite 301, Baltimore, MD 21224; e-mail, msocal1@jhu.edu.Author Contributions: Conception and design: G. Bai, M.P. Socal.Analysis and interpretation of the data: M.P. Socal.Drafting of the article: G. Bai, M.P. Socal.Critical revision of the article for important intellectual content: G. Bai, M.P. Socal.Final approval of the article: G. Bai, M.P. Socal.Administrative, technical, or logistic support: G. Bai.This article was published at Annals.org on 5 September 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics September 2023Volume 176, Issue 9Page: 1259-1260KeywordsDrug policyDrug pricesDrugsInsulinMedicaidMedicarePrevention, policy, and public healthPublic policy ePublished: 5 September 2023 Issue Published: September 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...